Tonsillitis

Tonsillitis is inflammation of the tonsils, the two lymphoid pads at the back of the throat that are part of the immune defences. It is usually caused by an infection — most often a virus (such as the common cold viruses, or the glandular-fever virus), and sometimes bacteria, classically group A streptococcus ('strep throat'). It is very common, especially in children and young people. The main features are a sore throat, pain on swallowing, tonsils that look red and swollen and may have white or yellow spots or coating, fever, and often tender swollen glands in the neck. Bad breath, headache and feeling unwell are common; a barking cough and runny nose point more toward a viral cause. Most tonsillitis is viral and gets better on its own within about a week with rest, fluids and pain relief. Antibiotics are only helpful when the cause is bacterial (strep), which doctors judge from the pattern of symptoms and sometimes a throat swab or a rapid strep test. Occasionally a collection of pus forms beside a tonsil (a quinsy/peritonsillar abscess), causing severe one-sided pain and difficulty opening the mouth, which needs urgent treatment. Repeated severe episodes sometimes lead to considering tonsil removal.

• Usually none — tonsillitis is diagnosed clinically from the throat and symptoms.
• Rapid strep test or throat swab — to check for group A streptococcus when bacterial infection is suspected.
• Full blood count — a high neutrophil count suggests bacterial, a high lymphocyte count may suggest a viral cause such as glandular fever.
• CRP — may be raised; helps gauge how much inflammation is present.
• Monospot / EBV tests — if glandular fever is suspected.

• Sore throat and pain on swallowing
• Red, swollen tonsils, sometimes with white or yellow spots
• Fever
• Tender, swollen glands in the neck
• Bad breath
• Headache and feeling generally unwell
• Severe one-sided throat pain with difficulty opening the mouth — a warning of an abscess (quinsy)